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Exodus of Men from Primary Care Drives Shift To Medical-Specialty Practice

Women and International Medical Graduates Mask Severity of Shift from Primary Care

WASHINGTON, DCAn exodus of men from primary care practice
is driving a marked shift in the physician workforce toward such specialties
as cardiology and dermatology, reinforcing concerns about a looming shortage
of primary care physicians, according to a new national study released today
by the Center for Studying Health System Change (HSC).

Two factors have helped mask the severity of the shift from primary carea
growing proportion of female physicians, who disproportionately choose primary
care, and continued reliance on international medical graduates (IMGs), who
now account for nearly a quarter of all U.S. primary care physicians, according
to the study.

Since 1996-97, a 40 percent increase in the female primary care physician supply
has helped to offset a 16 percent decline in the male primary care physician
supply relative to the U.S. population, the study found. At the same time, primary
care physicians incomes have lost ground to both inflation and medical and
surgical specialists incomes. And women in primary care face a 22 percent income
gap relative to men, even after accounting for differing characteristics.

"If real incomes for primary care physicians continue to decline, there
is a risk that the migration of male physicians will intensify and that female
physicians may begin avoiding primary caretrends that could aggravate a predicted
shortage of primary care physicians," said Paul B. Ginsburg, president
of HSC, a nonpartisan policy research organization funded principally by the
Robert Wood Johnson Foundation.

"As the U.S. population ages and many of the 76 million baby boomers develop
multiple chronic conditions, an adequate supply of primary care physicians will
be critical to meet the nations health care needs," said HSC Senior Researcher
Ha T. Tu, M.P.A., coauthor of the study with HSC Senior Researcher Ann OMalley,
M.D., M.P.H.

Over the last decade, the supply of medical specialists, such as cardiologists
and gastroenterologists, has increased significantly, while the supply of both
primary care physicians and surgeons has declined, according to the study. Among
physicians providing direct patient care at least 20 hours a week, the proportion
of medical specialists grew from 32.2 percent in 1996-97 to 37.6 percent in
2004-05, while the proportion of primary care physicians decreased from 38.9
percent to 36.7 percent. Likewise, the proportion of surgeons declined from
28.9 percent to 25.7 percent.

Based on HSCs nationally representative Community Tracking Study Physician
Survey, the studys findings are detailed in a new HSC Tracking ReportExodus
of Male Physicians from Primary Care Drives Shift To Specialty Practiceavailable
here. The 1996-97 and 2000-01 surveys contain information on about 12,000
patient-care physicians, and the 2004-05 survey includes responses from more
than 6,600 physicians. Response rates for the surveys range from 52 percent
to 65 percent. Other key study findings include:

Overall, from 1996-97 to 2004-05, there was a modest increase in the
patient-care physician population relative to the U.S. population131.9 physicians
per 100,000 people in 1996-97 compared with 136.2 physicians per 100,000 people
in 2004-05. However, the number of primary care physicians per capita fell slightly
as the number of male primary care physicians declined significantly from 39.3
per 100,000 people in 1996-97 to 33.0 per 100,000 in 2004-05. Without the increase
in the supply of female primary care physiciansfrom 12.1 per 100,000 in 1996-97
to 17.0 per 100,000 in 2004-05a larger reduction in the primary care workforce
relative to the population would have occurred.

Women accounted for a quarter of all patient-care physicians in 2004-05,
up from 18 percent in 1996-97. Female physicians are much more prevalent in
primary caremore than one in three primary care physicians is a woman, compared
with 22 percent of medical specialists and 17 percent of surgeons. And, among
female physicians in 2004-05, half practiced in primary care, one-third in medical
specialties, and only 17 percent in surgical specialties

Nearly one-fourth of the primary care physician workforce is composed
of international medical graduates, whose share of the primary care workforce
has remained stable at just more than 24 percent since 2000-01, after increasing
from 20.7 percent in the late-1990s.

On average, female primary care physicians earned about 30 percent
less than their male counterparts in 2003average reported net income of $114,316
vs. $162,934.

Male-female income gaps persisted even after controlling for personal
and practice characteristics, including specialty, years of experience, board
certification, IMG status, average hours worked, practice setting, proportions
of Medicaid and capitated revenue, and practice ownership status. Adjusted incomes
(controlling for personal and practice characteristics) revealed a 22 percent
gender gap in 2003 for primary care physicians-a gap that has widened since
1995, when it was 16 percent. In contrast, women in the medical specialties
have reduced the income gap considerably relative to their male counterparts.

### ###

The Center for Studying Health System Change is a nonpartisan policy research
organization committed to providing objective and timely research on the nations
changing health system to help inform policy makers and contribute to better
health care policy. HSC, based in Washington, D.C., is funded principally by
the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy
Research, Inc.